How To Make A Health Insurance Claim With Multiple Policies

By Adhil Shetty | September 15, 2017

How To Make A Health Insurance Claim With Multiple Policies

Most employed people have a group health cover offered by their employer.  With rising medical costs, many people opt for independent Health Insurance policies or family protection plans to broaden the coverage on its offer.

While buying multiple Health Insurance policies is a good idea, using them just as effectively is equally significant.

Let us take a look at some crucial points you should know while making a claim for possessing multiple Health Insurance plans.

Disclosure Of Health Covers To The Insurer

When you opt for a second health cover, it is important to disclose the existing health cover details to the new insurer. The primary reason behind such a norm is that the first policy usually forms the basis of underwriting of the second Health Insurance plan.

Earlier, the government norms as prescribed by IRDAI meant that health insurers had to abide by a contribution clause, which meant that a claim needs to be shared by both the insurers as per the proportion of sum insured. The contribution clause although has undergone a change, and today you can choose to seek claims from either of the insurer, non-disclosure still violates the terms and conditions of the health plan.  The new norms of contribution clause comes into effect only if the claim amount is more than the sum assured of the policy.

For example, if Mr. A has one Health Insurance plan worth Rs. 2 Lakhs from insurer X and one from insurer Y. Now, if the claim amount for Mr. A is Rs. 1 Lakhs (or lower than the sum insured), he is free to choose the insurer to request for a claim settlement as per the policy terms and conditions. There is no contribution clause in such a scenario.

In case the claim amount exceeds the sum insured, Mr. A still has the right to choose the first insurer to seek the claim, but the claim will be settled as per the contribution clause. A non-disclosure to insurer X about a Health Insurance plan with insurer Y will mean insurer X will be liable to pay only up to the sum insured and remaining money must be paid by Mr. A himself.

Contribution clause also does not usually get implemented on defined benefit policies as the payable amount is usually fixed for such plans.

Things To Know Before Making Multiple Claims

When you file for claims with the first insurer in the event of multiple insurers involved, the claim amount to be settled by insurer 1 is calculated after calculating for any deductibles or co-pay. Once the first insurer settles the claim and you file the claim with the second insurer, it will arrive at the payable claim amount and deduct the amount paid by the first insurer.

Steps Involved In Multiple Health Insurance Claims

  • Intimate or inform all insurers at the time of hospitalisation
  • For claims, you can choose which insurer to opt for first, and fill in the claim form with attached bills and documents
  • After the first insurer settles the amount, request for a claim settlement summary and file claim with the second insurer
  • You will need to submit the claim settlement summary from the first insurer along with the claim form
  • The second insurer will then settle the remaining amount as per policy terms and conditions

Opting for multiple Health Insurance plans requires due diligence in both claim filing process as well as intimation of a health cover to a new insurer.

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About Adhil Shetty

Adhil Shetty is the Founder and serves as the Chief Executive Officer of BankBazaar.com. Adhil has a Master’s degree in International Relations with a specialization in International Finance and Business from Columbia University in the City of New York, and a Bachelor’s degree in Engineering from the College of Engineering Guindy, Anna University. Adhil is an expert in Personal Finance (Car loan/Home loan and personal loan) and he majorly consults on investment and spends rationalization for the Indian loan borrowers. His guidance is number based with real time interest rate calculations and hence useful for consumer’s real time query.

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